2014年上海市细菌耐药性监测

发布时间：2018-04-20 09:30

本文选题：细菌耐药性监测 + 药敏试验　；参考：《中国感染与化疗杂志》2016年02期

【摘要】：目的了解2014年上海市细菌耐药性监测情况。方法采用纸片扩散法(K-B法)或自动化仪器法对上海市40所医院的临床分离菌进行药敏试验。包括28所三级医院和12所二级医院,其中含3所儿童医院。采用CLSI 2014年版标准判断结果。结果总计102 113株临床分离菌,革兰阳性菌27 482株,占26.9%;革兰阴性菌74 631株,占73.1%。MRSA和MRCNS的检出率分别为47.4%和79.8%。MRSA、MRCNS在二级医院和三级医院的平均检出率分别为51.1%、79.9%和46.6%、79.8%。葡萄球菌属中未发现万古霉素和替考拉宁耐药株。845株儿童非脑膜炎分离株中青霉素敏感(PSSP)、中介(PISP)和耐药(PRSP)株的检出率分别为70.1%、14.6%和15.4%;167株成人分离株的PSSP、PISP和PRSP分别为97.6%、1.2%和1.2%。发现67株屎肠球菌和14株粪肠球菌耐万古霉素。根据PCR测序,多数万古霉素耐药肠球菌为van A和van M基因型。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌中ESBL的检出率分别为59.4%、35.9%和30.1%。上述ESBL菌株在二级医院和三级医院的检出率分别为61.6%、31.6%、35.0%和58.9%、36.9%、29.5%。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,对亚胺培南和美罗培南的总耐药率均为7.0%。鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌中有少数对所有测试药物耐药的广泛耐药株。分离自尿液标本中的肠球菌属和大肠埃希菌对磷霉素的耐药率低。结论细菌耐药性仍对临床构成严重威胁,临床需合理规范应用抗菌药物,避免耐药株的广泛传播。
[Abstract]:Objective to investigate the surveillance of bacterial resistance in Shanghai in 2014. Methods Drug sensitivity tests were carried out in 40 hospitals in Shanghai by disk diffusion method (K B method) or automatic instrument method. Including 28 level III hospitals and 12 level II hospitals, including 3 children's hospitals. CLSI 2014 version of the standard judgment results. Results A total of 102 113 clinical isolates were isolated, 27 482 Gram positive bacteria (26. 9%), 74 631 Gram-negative bacteria (47.4%) and 79.8% (79.8%) MRCNS were detected in the second and third level hospitals respectively. The average detectable rates of Gram-negative bacteria 74,631 and MRCNS were 51.1% and 46.69.8%, respectively. No vancomycin and teicoplanin resistant strains were found in the genus Staphylococcus. The detection rates of penicillin sensitive PISP (PISPN) and resistant PRSPSPs were 70.1% and 14.6%, respectively, and PRSP were 97.61.2% and 1.2%, respectively, for 1.167 adult isolates of vancomycin and teicoplanin. 67 strains of Enterococcus faecium and 14 strains of Enterococcus faecalis were found to be vancomycin resistant. According to PCR sequencing, most of the vancomycin resistant Enterococcus isolates were van A and van M genotypes. The positive rates of ESBL in Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were 59.439% and 30.1%, respectively. The detectable rate of the above ESBL strains was 35.0% and 36.9% in the second grade hospital and the third grade hospital, respectively. Enterobacteriaceae bacteria are still highly sensitive to carbapenem antibiotics and the total resistance rates to imipenem and meropenem are both 7.0. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli have a small number of widely resistant strains tested for drug resistance. Enterococcus and Escherichia coli isolated from urine samples showed low resistance to fosfomycin. Conclusion Drug resistance of bacteria still poses a serious threat to clinical practice. It is necessary to regulate the use of antimicrobial agents in order to avoid the widespread spread of drug resistant strains.
【作者单位】：复旦大学附属华山医院;东方肝胆外科医院;复旦大学附属儿科医院;复旦大学附属妇产科医院;复旦大学附属华东医院;复旦大学附属金山医院;复旦大学附属中山医院;复旦大学附属上海市第五人民医院;长海医院;上海长征医院;上海交通大学附属第六人民医院;上海交通大学附属第一人民医院;上海交通大学附属儿童医院;上海交通大学医学院附属第九人民医院;上海交通大学医学院附属第三人民医院;上海交通大学医学院附属儿童医学中心;上海交通大学医学院附属仁济医院(浦东);上海交通大学医学院附属仁济医院(浦西);上海交通大学医学院附属瑞金医院;上海交通大学医学院附属新华医院;上海市长宁区中心医院;上海市崇明县中心医院;上海市第八人民医院;上海市第二人民医院;上海市奉贤区中心医院;上海市嘉定区中心医院;上海市浦东新区人民医院;上海市浦东医院;上海市普陀区人民医院;上海市普陀区中心医院;上海市青浦区中心医院;上海市松江区中心医院;上海市杨浦区中心医院;上海中医药大学附属龙华医院;上海中医药大学附属曙光医院;上海中医药大学附属岳阳中西医结合医院;同济大学附属第十人民医院;同济大学附属东方医院;同济大学附属同济医院;中国人民解放军第四五五医院;
【分类号】：R446.5

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